	<form action="{FORMACTION}" method="post">
	  <table class="fullwidth" >
		  <tr class="tblheader">
			<td colspan="3">
			  {AGREEMENT_HEADER}
			</td>
		  </tr>
		  <tr>
			<td class="option" align="top">{TXT_AGREEMENT}</td>
			<td class="option_value">
			  {TXT_INFO_AGREEMENT}<br />
			  <ul class="il_listItem">
				<!-- BEGIN field -->
				<li>{FIELD_NAME}</li>
				<!-- END field -->
			  </ul>
			  <!-- BEGIN cdf -->
			  {CDF_TXT}
			  <ul>
				<!-- BEGIN cdf_row -->
				<li style="padding-bottom: 5px">
				  {CDF_FIELD_NAME}<!-- BEGIN cdf_required --><font class="warning">*</font><!-- END cdf_required -->:<br />
				  <!-- BEGIN sel_row -->
				  {SEL_SELECT}
				  <!-- END sel_row -->
				  <!-- BEGIN txt_row -->
				  <input type="text" name="cdf[{TXT_ROW_NAME}]" value="{TXT_ROW_VALUE}" size="32" maxlength="64" />
				  <!-- END txt_row -->
				</li>
				<!-- END cdf_row -->
			  </ul>
			  <!-- END cdf -->
			</td>
		  </tr>
		  <!-- BEGIN agreement -->
		<tr>
		  <td class="option" align="top">{TXT_AGREE}</td>
		  <td class="option_value">
			{CHECK_AGREE} {INFO_AGREE}
		  </td>
		</tr>
		  <!-- END agreement -->
		<tr>
		  <td class="submit" colspan="3">
			<!-- BEGIN info_required -->
			<div style="float:left">
			  <font class="warning">* </font>{TXT_REQUIRED}
			</div>
			<!-- END info_required -->
			<div align="right">
			  <input class="submit" type="submit" name="cmd[save]" value="{TXT_SAVE}" />
			</div>
		  </td>
		</tr>
	  </table>
	</form>
	